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Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
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The working paper is divided into two main parts. The first part is a descriptive analysis of the illicit use of biological agents by criminals and terrorists. It draws on a series of case studies documented in the second part. The case studies describe every instance identifiable in open source materials in which a perpetrator used, acquired, or threatened to use a biological agent. While the inventory of cases is clearly incomplete, it provides an empirical basis for addressing a number of important questions relating to both biocrimes and bioterrorism. This material should enable policymakers concerned with bioterrorism to make more informed decisions. In the course of this project, the author has researched over 270 alleged cases involving biological agents. This includes all incidents found in open sources that allegedly occurred during the 20th Century. While the list is certainly not complete, it provides the most comprehensive existing unclassified coverage of instances of illicit use of biological agents.